Life Support: Three Nurses on the Front Lines

by Laurie

in burn-out, hospital mergers, nursing, primary nursing

In Life Support:Three Nurses on the Front Lines (1997), Suzanne Gordon, a non-nurse journalist who writes passionately about nursing, showcases the personal and professional lives of three expert nurses at Boston’s Beth Israel Hospital during the glory days of primary nursing. Before the mergers and cuts of Managed Care in the mid-90s, these nurses practiced at full capacity, improving their patients’ lives and experiencing professional satisfaction in the process.

Even though the book was published in 1997, fifteen years later, with our healthcare system still languishing on the critical list, this book remains valuable and relevant for patients and professionals and everyone who wonders why nurses are so unhappy.

For almost three years, just before the botched merger of Boston’s Beth Israel Hospital with Deaconess Hospital in 1996, Gordon shadowed three B.I. nurses: Jeannie Chaisson, a clinical nurse specialist on a general medical floor; Nancy Rumplik, a nurse working in an out-patient oncology clinic; and Ellen Kitchen, a geriatric nurse practitioner working in Beth Israel’s home care department. Shining a journalistic light on the lived experiences of these three nurses illuminates the all-too-invisible world of what nurses know and how they use their knowledge to benefit patients. With clarity and sensitivity, Gordon shows how these nurses create therapeutic relationships with patients that establish foundations of trust upon which all care rests.

Early in the book, Gordon recounts the implementation of primary nursing at Beth Israel Hospital in the 70s under the leadership of Joyce Clifford and Trish Gibbons. Primary nursing, as developed by Marie Manthey and others, is a decentralized system of delivering nursing care to patients in which bedside nurses are given the authority to make nursing decisions for which they are responsible and accountable. At the core of primary nursing is a therapeutic relationship between the nurse and her patient and the patient’s family. Ideally, the primary nurse works with the patient throughout his or her hospitalization and during readmissions whenever possible. In contrast to primary nursing, team nursing relies on less well-educated workers providing direct care under the supervision of an RN.

Historically, the best clinical nurses were pulled from the bedside and plopped into head nurse positions, usually with little training. At Beth Israel Hospital, career ladders were introduced whereby clinical nurses could advance professionally and still remain at the bedside. Although not a necessary component of primary nursing, Beth Israel hired an all RN-BSN staff and encouraged RNs with two and three years of training to return to school for undergraduate and graduate degrees. It is worthwhile noting that during the nursing shortages of the 80s, Beth Israel had to turn qualified nurses away.

Interspersed with details of the three nurses’ personal and educational stories, Gordon deftly recounts the history of nursing and describes the differences in preparation among associate degree, diploma, and baccalaureate degree nurses; the differences between team nursing and primary nursing; the role differences between nurse practitioners and clinical nurse specialists; and the differences between medical and nursing approaches to patient care. Few physicians and other healthcare professionals are aware of these dynamics. Gordon lays out the sometimes contentious relationships between doctors and nurses–much of it based on ignorance–and contrasts this with collaborative relationships that result in better patient outcomes.

Later in the book Gordon details how managed care has mangled care for patients and strangled the professional hearts and souls of nurses. Even though I lived this reality and wrote about the same issue in my book, reliving it again still makes my blood boil.

Suzanne Gordon does not try to hide her exasperation for nurses who consider unionization “unprofessional.” Nurses not protected by a union contract have little recourse if they blow the whistle on unsafe patient care practices such as premature discharges, inadequate staffing, and the use of unlicensed personnel. Although Life Support is not preoccupied with gender politics, Gordon’s feminist roots are evident throughout the book.

Nurses know that far from stanching the flow of blood from our healthcare system, cutting nurses will hasten the bleeding. As Suzanne Gordon suggests, “…we should target the real health care cost escalators–the exorbitant salaries of hospital administrators and insurance executives, the incomes of high-priced medical specialists, the outrageously inflated cost of drugs and medical equipment, the construction of unnecessary hospital facilities and purchase of redundant technology, and wasteful health plan and hospital marketing and advertising.”

Gordon makes a point that bears repeating: “Investor-owned managed care companies are legally mandated to increase profits for shareholders.” They do so on the backs of caregivers, patients, and physicians.

Here’s where I make a pitch for nurses to shed the invisibility cloak and reveal what they do, why they do it, and how it makes a difference in their patients’ lives. Equally important is for nurses to explain what they COULD BE doing but can’t because of short-sightedness and limited resources AND how it costs more in the long run. We can’t force people with decision-making power to listen, but with three million plus nurses in this country, surely enough of us can raise a ruckus so that they must.

That said, here is your writing assignment: In your practice area, given a reasonable budget to enact your plan, what measures would you institute anywhere in the system that would result in improved patient care and significant cost savings five years down the road?

I look forward to publishing the best of your suggestions in these pages. Please send them to me at thecomfortgarden2011@gmail.com.

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